Suture-locking washer for use with a bone anchor, and method for supporting the thumb of a patient after basal joint arthroplasty, and other novel orthopedic apparatus and other novel orthopedic procedures

ABSTRACT

The invention provides surgical methods, devices, apparatus, and systems for supporting the thumb of a patient after basal joint arthroplasty. The embodiments of the invention comprise at least one index metacarpal anchor, at least one thumb metacarpal anchor, at least one sling for positioning the thumb metacarpal anchor relative to the index metacarpal anchor, and at least one anchor washer for tightening and securing the sling(s) without the need to tie the suture(s) components of the sling(s) into knots. Index and thumb metacarpal anchors comprise at least one bone-engaging element for engaging the respective metacarpal. The anchor washer may incorporate one or more sling-engagement mechanisms. Increasing the number of sling-engagement mechanisms associated with the anchor washer increases the surface area of the sling(s) and provides multiple sling elements to provide redundancy and increase the pull force of the sling(s) attachment(s) used to affix the thumb and index metacarpal anchors into a position relative to each other.

REFERENCE TO PENDING PRIOR PATENT APPLICATIONS

This patent application:

(1) is a continuation-in-part of U.S. patent application Ser. No.14/596,973, filed Jan. 14, 2015 by CMC Group LLC and Izi Bruker et al.for SLING SUSPENSION SYSTEM FOR SUPPORTING THE THUMB OF A PATIENT AFTERBASAL JOINT ARTHROPLASTY, which patent application:

-   -   (a) claims benefit of prior U.S. Provisional Patent Application        Ser. No. 61/927,309, filed Jan. 14, 2014 by CMC Group LLC and        Izi Bruker et al. for BASAL THUMB ARTHRITIS SLING SYSTEM; and

(2) claims benefit of U.S. Provisional Patent Application Ser. No.62/546,187, filed Aug. 16, 2017 by CMC Group LLC and Sidney Fleischmanet al. for SUTURE-LOCKING WASHER FOR USE WITH A BONE ANCHOR, AND METHODFOR SUPPORTING THE THUMB OF A PATIENT AFTER BASAL JOINT ARTHROPLASTY.

The three (3) above-identified patent applications are herebyincorporated herein by reference.

FIELD OF THE INVENTION

This invention relates to novel orthopedic medical devices for lockingan elongated element (e.g., a suture) to a bone anchor in order toreposition bone, soft tissue, or other anatomy, and to a novel slingsuspension system for supporting the thumb of a patient after basaljoint arthroplasty.

The novel orthopedic medical devices of the present invention may,alternatively, relate to tenodesis applications, or other softtissue-to-bone attachment applications, in which conventional screwanchors (or other types of anchors), or other implantable medicaldevices, are augmented with novel suture attachment mechanisms thatobviate the need to tie knots in the suture when attaching the suture toa bone anchor (or to another implantable medical device) or to tissue.

BACKGROUND OF THE INVENTION

Degenerative osteoarthritis of the first metacarpal joint of the thumb(sometimes referred to as “the basal joint”) is a common debilitatingcondition, especially in middle-aged women. Research shows that 25% ofall women and 8% of all men in their fifties complain of pain in thebase of the thumb, secondary to basal joint osteoarthritis. Basal jointarthritis can cause substantial pain, digit weakness and loss offunctionality.

In severe cases of basal joint arthritis, basal joint reconstruction maybe required. In general, basal joint reconstruction involves trapezialexcision (sometimes referred to as “basal joint arthroplasty”), which isrequired for pain relief, and subsequent soft tissue reconstruction inorder to restore proper balance, alignment, longitudinal length andfunction to the thumb.

Unfortunately, such soft tissue reconstruction has traditionallyinvolved harvesting tendons which are subsequently transferred andre-directed via drill holes in the thumb metacarpal in order to restoreproper balance, alignment, longitudinal length and function to thethumb. However, this means harvesting, and thereby sacrificing, all orsome of one or more existing, functioning tendons. In addition, suchsoft tissue reconstruction typically requires temporary pinning of theanatomy, which can give rise to pin tract complications such asinfection, nerve damage and neuroma formation.

As a result, a new approach is needed for effecting basal jointreconstruction after performing basal joint arthroplasty in order toalleviate basal joint arthritis.

In addition to the foregoing, in many situations, anatomical objects(e.g., bone, soft tissue, prostheses, etc.) need to be attached Lo oneanother. And in many situations, it may be desirable to effect thisattachment with suture. However, it can sometimes be problematic to tieknots in the suture so as to fix the anatomical objects relative to oneanother. In addition, it can sometimes be problematic to formthrough-holes in bone to secure the suture to the bone. Therefore, a newapproach is needed for making knotless fixations of anatomical objectswithout having to drill through-holes in bone.

SUMMARY OF THE INVENTION

The present invention comprises the provision and use of novelsuture-securing mechanisms that enable the tightening and locking (e.g.,cinching) of suture to an anchor or other implantable medical devicewithout the need to tie knots in the suture in order to adjustablysecure the suture to the anchor or other implantable medical device.

In one preferred form of the invention, there is provided suture-lockingwashers which are mounted to bone anchors, wherein the suture-lockingwashers comprise suture-securing mechanisms.

The present invention also comprises the provision and use of boneanchors and novel suture-locking washers for use as part of a novelsling suspension system which may be used to effect basal jointreconstruction after performing basal joint arthroplasty in order toalleviate basal joint arthritis.

More particularly, in one preferred form of the invention, the inventioncomprises suture-locking washers comprising suture-securing mechanisms,wherein the suture-locking washers are utilized in combination with boneanchors to form a novel sling suspension system which can be used tojoin the thumb metacarpal to the index metacarpal, whereby to enabletightening and locking (e.g., cinching) of a sling (e.g., a suture) ofthe sling suspension system so as to support the thumb of a patientafter basal joint arthroplasty. The present invention eliminates thespecific complications and increased morbidity associated with tendonharvesting and transfer procedures, and also eliminates thecomplications and increased morbidity associated with those proceduresthat require temporary pin fixation or drill holes for tendon or suturepassage. The novel sling suspension system of the present inventionprovides secure and stable support for the thumb of a patient afterperforming basal joint arthroplasty so as to alleviate basal jointarthritis, and is fast and simple to use, since the suture-securingmechanism of the suture-locking washer eliminates the need to tie knotsin the suture in order to secure the suture to a bone anchor.

In one preferred form of the invention, there is provided a slingsuspension system for supporting the thumb of a patient after basaljoint arthroplasty, the sling suspension system comprising:

an index metacarpal anchor;

a thumb metacarpal anchor; and

a sling (e.g., a suture) for securing the thumb metacarpal anchor to theindex metacarpal anchor;

the index metacarpal anchor comprising at least one bone-engagingelement for securing the index metacarpal anchor to bone and asling-engaging element for capturing the sling to the index metacarpalanchor;

the thumb metacarpal anchor comprising at least one bone-engagingelement for securing the thumb metacarpal anchor to bone and asling-engaging element for capturing the sling to the thumb metacarpalanchor;

the sling comprising an elongated body having a first anchor-engagingelement for securing the sling to the sling-engaging element of theindex metacarpal anchor, and a second anchor-engaging element forsecuring the sling to the sling-engaging element of the thumb metacarpalanchor;

wherein the at least one sling-engaging element of the thumb metacarpalanchor comprises at least one suture-locking washer for adjustablysecuring the sling to the thumb metacarpal anchor.

In another preferred form of the invention, there is provided a methodfor supporting the thumb of a patient after basal joint arthroplasty,the method comprising:

securing a first end of a sling to an index metacarpal anchor;

positioning the index metacarpal anchor in the index metacarpal;

adjustably securing the second end of the sling to a thumb metacarpalanchor;

inserting the thumb metacarpal anchor into the thumb metacarpal; and

tightening the sling (e.g., a suture) in one direction through anadjustable suture-securing mechanism of the thumb metacarpal anchor soas to fixedly connect the thumb metacarpal to the index metacarpal.

In one preferred form of the invention, the suture-securing mechanism ofthe thumb metacarpal anchor is provided via a suture-locking washerwhich is secured to the thumb metacarpal anchor.

In another preferred form of the invention, there is provided a methodfor alleviating basal joint arthritis, the method comprising:

excising the trapezium of a patient;

securing a first end of a sling (e.g., a suture) to an index metacarpalanchor;

positioning the index metacarpal anchor in the index metacarpal;

adjustably securing the second end of the sling to a thumb metacarpalanchor;

inserting the thumb metacarpal anchor into the thumb metacarpal; and

tightening the sling by pulling a free end of the sling relative to asuture-securing mechanism of the thumb metacarpal anchor so that thesecond end of the sling is fixedly secured to the thumb metacarpalanchor, whereby the sling fixedly connects the thumb metacarpal to theindex metacarpal.

In one preferred form of the invention, the suture-securing mechanism ofthe thumb metacarpal anchor is provided via a suture-locking washerwhich is secured to the thumb metacarpal anchor.

In another preferred form of the invention, the suture-locking washer(which carries the suture-securing mechanism) is formed integral withthe thumb metacarpal anchor.

In another preferred form of the invention, the suture-locking washer(which carries the suture-securing mechanism) is mounted to a boneanchor (which may be used as the thumb metacarpal anchor, or as theindex metacarpal anchor, or as an anchor for other locations within thebody) or to another implantable medical device.

And in another preferred form of the invention, the suture-securingmechanism may be incorporated directly into a bone anchor (which may beused as the thumb metacarpal anchor, or as the index metacarpal anchor,or as an anchor for other locations within the body) or into anotherimplantable medical device.

And in another form of the invention, a novel method and apparatus isprovided for effecting knotless fixations of anatomical objects.

In another form of the invention, there is provided a sling suspensionsystem for supporting the thumb of a patient after basal jointarthroplasty, the sling suspension system comprising:

an index metacarpal anchor;

a thumb metacarpal anchor; and

a sling for securing said thumb metacarpal anchor to said indexmetacarpal anchor;

said index metacarpal anchor comprising at least one bone-engagingelement for securing said index metacarpal anchor to an indexmetacarpal, and a sling-engaging element for attaching said sling tosaid index metacarpal anchor;

said thumb metacarpal anchor comprising at least one bone-engagingelement for securing said thumb metacarpal anchor to a thumb metacarpal,and a sling-engaging element for attaching said sling to said thumbmetacarpal anchor;

wherein at least one of said sling-engaging element of said thumbmetacarpal anchor and said sling-engaging element of said indexmetacarpal anchor comprises a sling-securing mechanism which isconfigured to provide one-way movement of said sling relative to saidsling-securing mechanism.

In another form of the invention, there is provided a method forsupporting the thumb of a patient after basal joint arthroplasty, saidmethod comprising:

providing a sling suspension system, said sling suspension systemcomprising:

-   -   an index metacarpal anchor;    -   a thumb metacarpal anchor; and    -   a sling for securing said thumb metacarpal anchor to said index        metacarpal anchor;    -   said index metacarpal anchor comprising at least one        bone-engaging element for securing said index metacarpal anchor        to an index metacarpal, and a sling-engaging element for        attaching said sling to said index metacarpal anchor;    -   said thumb metacarpal anchor comprising at least one        bone-engaging element for securing said thumb metacarpal anchor        to a thumb metacarpal, and a sling-engaging element for        attaching said sling to said thumb metacarpal anchor;    -   wherein at least one of said sling-engaging element of said        thumb metacarpal anchor and said sling-engaging element of said        index metacarpal anchor comprises a sling-securing mechanism        which is configured to provide one-way movement of said sling        relative to said sling-securing mechanism;

attaching said sling to said sling-engaging element of said indexmetacarpal anchor and attaching said sling to said sling-engagingelement of said thumb metacarpal anchor;

positioning said index metacarpal anchor in an index metacarpal;

inserting said thumb metacarpal anchor into a thumb metacarpal; and

moving said sling through said sling-securing mechanism so as to shortenthe length of said sling extending between said index metacarpal anchorand said thumb metacarpal anchor so as to fixedly connect the thumbmetacarpal to the index metacarpal.

In another form of the invention, there is provided apparatus forsecuring a first anatomical object to a second anatomical object, saidapparatus comprising:

a body having an opening; and

a tubular structure disposed in said opening, said tubular structurecomprising a side wall defining a passageway, a portion of said sidewall of said tubular structure projecting into said passageway so as toprovide one-way movement of a filament through said passageway.

In another form of the invention, there is provided a method forsecuring a first anatomical object to a second anatomical object, saidmethod comprising:

providing apparatus for securing the first anatomical object to thesecond anatomical object, said apparatus comprising:

-   -   a body having an opening; and    -   a tubular structure disposed in said opening, said tubular        structure comprising a side wall defining a passageway, a        portion of said side wall of said tubular structure projecting        into said passageway so as to provide one-way movement of a        filament through said passageway;

passing a filament through said passageway;

associating one end of said filament with the second anatomical objectand associating said body with the first anatomical object; and movingsaid filament through said passageway so as to shorten the length ofsaid filament extending between the first anatomical object and thesecond anatomical object so as to fixedly connect the first anatomicalobject to the second anatomical object.

BRIEF DESCRIPTION OF DRAWINGS

These and other objects and features of the present invention will bemore fully disclosed or rendered obvious by the following detaileddescription of the preferred embodiments of the invention, which is tobe considered together with the accompanying drawings wherein likenumbers refer to like parts, and further wherein:

FIG. 1 is a schematic view showing the bone structure of the right handof a human;

FIG. 2 is a schematic view showing a basal joint reconstruction usingthe novel sling suspension system of the present invention;

FIG. 3 is a schematic view showing a novel sling suspension systemformed in accordance with the present invention, wherein the novel slingsuspension system comprises an index metacarpal anchor with a suturesecured thereto, and a thumb metacarpal anchor with a suture adjustablysecured thereto, wherein the suture is adjustably secured to the thumbmetacarpal anchor via a suture-locking washer;

FIGS. 4-11 are various views of selected portions of the novel slingsuspension system shown in FIG. 3;

FIG. 12 is a flattened view of selected portions of the suture-securingmechanism of the suture-locking washer shown in FIGS. 4-11;

FIGS. 13-15 are schematic views showing another novel suture-securingmechanism formed in accordance with the present invention, wherein thesuture-securing mechanism comprises a plurality of protrusions whichfacilitate mounting the suture-securing mechanism to a suture-lockingwasher;

FIG. 16 is an perspective schematic view of the suture-securingmechanism shown in FIGS. 13-15;

FIGS. 17-23 are schematic views of another novel suture-locking washerformed in accordance with the present invention;

FIGS. 24-27 are various schematic sectional views of the suture-lockingwasher of FIGS. 17-23;

FIGS. 28-30 are schematic views of a deployment assembly for deployingthe novel sling suspension system of the present invention;

FIGS. 31 and 32 are schematic views of another deployment assembly fordeploying the novel sling suspension system of the present invention;

FIGS. 33-53 are schematic views illustrating another novelsuture-locking washer and thumb metacarpal anchor formed in accordancewith the present invention;

FIGS. 54-57 are schematic views illustrating another novelsuture-locking washer and thumb metacarpal anchor formed in accordancewith the present invention;

FIGS. 58-61 are schematic views illustrating how the suture-securingmechanisms of the present invention may be mounted within thesuture-locking washers;

FIGS. 62-65 are various schematic views of a component which may beincorporated into a suture-locking washer, wherein the componentincorporates a suture-securing mechanism;

FIG. 66 is a schematic view showing another novel sling suspensionsystem formed in accordance with the present invention;

FIG. 67 is a schematic view showing another novel system formed inaccordance with the present invention and useful for effecting asurgical repair; and

FIG. 68-72 are schematic views showing exemplary surgical repairsperformed in accordance with the present invention.

DETAILED DESCRIPTION OF THE PREFERRED EMBODIMENTS

The Human Hand

Looking first at FIG. 1, there is shown the right hand 5 of a human. Asseen in the figure, the basal joint 10 is formed at the junction of thethumb metacarpal 15 and the trapezium 20. Note also the location of theadjacent index metacarpal 25.

As noted above, many people suffer from significant basal jointarthritis and would benefit from basal joint reconstruction in order toalleviate the basal joint arthritis.

Basal Joint Reconstruction

The present invention provides a new approach for effecting basal jointreconstruction after performing basal joint arthroplasty in order toalleviate basal joint arthritis.

More particularly, and looking now at FIG. 2, the present inventioncomprises the provision and use of a novel sling suspension system 30that joins the thumb metacarpal to the index metacarpal so as to supportthe thumb of a patient after basal joint arthroplasty.

As will hereinafter be discussed in further detail, and still looking atFIG. 2, novel sling suspension system 30 generally comprises an indexmetacarpal anchor 35 having a sling (e.g., a suture) 40 fixedly securedthereto, and a thumb metacarpal anchor 45 having sling (e.g., a suture)40 adjustably secured thereto.

And as will hereinafter be discussed, novel sling suspension system 30may be used in a procedure to alleviate basal joint arthritis, wherein:

the trapezium of a patient is excised;

the index metacarpal anchor is positioned in the index metacarpal;

the thumb metacarpal anchor is positioned in the thumb metacarpal; and

the sling is tightened by pulling a free end of the sling relative to asuture-securing mechanism of the thumb metacarpal anchor so that thesling is fixedly secured to the thumb metacarpal anchor, whereby thesling fixedly connects the thumb metacarpal to the index metacarpal.

The novel sling suspension system of the present invention providessecure and stable support for the thumb of a patient after performingbasal joint arthroplasty in order to alleviate basal joint arthritis,and is relatively fast and simple to implement.

More particularly, the present invention comprises the provision and useof a suture-securing mechanism which may be used in concert with one ormore bone anchors for effecting basal joint reconstruction afterperforming basal joint arthroplasty to alleviate basal joint arthritis.

In one form of the present invention, the invention comprises theprovision and use of a novel sling suspension system comprising aknotless sling attachment that can be used to join the thumb metacarpalto the index metacarpal in order to support the thumb of a patient afterbasal joint arthroplasty.

The present invention eliminates the specific complications andincreased morbidity associated with tendon harvesting and transferprocedures, as well as the specific complications and increasedmorbidity associated with those procedures that require temporary pinfixation or drill holes for tendon or suture passage.

In one preferred form of the invention, the novel sling suspensionsystem comprises at least one suture-locking washer for use with a boneanchor, wherein the at least one suture-locking washer comprises atleast one suture-securing mechanism to enable tightening and securing(e.g., cinching) of a suture (i.e., the “sling”) once appropriateanchors (e.g., an index finger screw anchor, a thumb screw anchor, etc.)are positioned in the anatomy so as to provide stable support for thethumb of a patient after performing basal joint arthroplasty, whereby toalleviate basal joint arthritis. The novel sling suspension system ofthe present invention is relatively fast and simple to implement.

The Novel Sling Suspension System Utilizing Novel Suture-Locking Washers

As noted above, many people suffer from significant basal jointarthritis and would benefit from basal joint reconstruction to alleviatethe basal joint arthritis.

FIG. 3 shows a novel sling suspension system 30 for disposition in andbetween an index finger and a thumb of a human hand.

Sling suspension system 30 generally comprises index metacarpal anchor35 for deployment in index metacarpal 25, thumb metacarpal anchor 45 fordeployment in thumb metacarpal 15, and sling 40 (e.g., a suture) forsecuring thumb metacarpal anchor 45 to index metacarpal anchor 35,whereby to support the thumb of a patient after basal joint arthroplastyhas been performed in order to alleviate basal joint arthritis. See FIG.3. Although sling 40 will hereinafter generally be discussed in thecontext of a suture “sling”, it should be appreciated that sling 40 maycomprise substantially any elongated flexible element, and is notintended to be limited to suture. In addition, it should also beappreciated that sling 40 may comprise structure in addition to anelongated flexible element (e.g., a suture). By way of example but notlimitation, sling 40 may comprise a hammock-like structure mounted toone or more elongated flexible elements (e.g., sutures), such that theone or more elongated flexible elements (e.g., sutures) may be mountedto index metacarpal anchor 35 and thumb metacarpal anchor 45, and thehammock-like structure may engage and support portions of thumbmetacarpal 15.

Index metacarpal anchor 35 is intended to be deployed in (e.g., screwedinto or pushed into) a drill hole (i.e., a bone hole) formed at or nearthe base of index metacarpal 25. See FIG. 2.

Alternatively, index metacarpal anchor 35 may comprise a self-tappinganchor, in which case the bone hole is formed during delivery of thebone anchor into the index metacarpal. Index metacarpal anchor 35comprises a body 50 having at least one bone-engaging element 55 (e.g.,screw threads, ribs, etc.) (see FIG. 3) formed thereon for engaging theside wall of the bone hole, i.e., for engaging index metacarpal 25. Inthis way, index metacarpal anchor 35 can be secured to index metacarpal25. Index metacarpal anchor 35 further comprises a sling-engagingelement 60 (e.g., a recessed eyelet) (see FIG. 3) for capturing sling 40to index metacarpal anchor 35.

Thumb metacarpal anchor 45 is intended to be deployed in (e.g., screwedinto or pushed into) a drill hole (i.e., a bone hole) formed at or nearthe base of thumb metacarpal 15. See FIG. 2. Alternatively, thumbmetacarpal anchor 45 may comprise a self-tapping anchor, in which casethe bone hole is formed during delivery of the bone anchor into thethumb metacarpal. Thumb metacarpal anchor 45 comprises a body 65 havingat least one bone-engaging element 70 (e.g., screw threads, ribs, etc.)(see FIG. 3) formed thereon for engaging the side wall of the bone hole,i.e., for engaging thumb metacarpal 15. In this way, thumb metacarpalanchor 45 can be secured to thumb metacarpal 15. Thumb metacarpal anchor45 further comprises a suture-locking washer 75 (i.e., a sling-engagingelement) for mounting to thumb metacarpal anchor 45 and for adjustablygripping and securing sling 40 to thumb metacarpal anchor 45 as willhereinafter be discussed in further detail. In one preferred form of theinvention, suture-locking washer 75 comprises a body having a holeformed therein (see FIG. 7) for mounting the suture-locking washer tothumb metacarpal anchor 45. In one preferred form of the invention,suture-locking washer 75 is rotatably secured to thumb metacarpal anchor45 so that suture-locking washer 75 is able to traverse (i.e., rotate)360 degrees around the longitudinal axis of body 65 of thumb metacarpalanchor 45. By way of example but not limitation, suture-locking washer75 is rotatably mounted to thumb metacarpal anchor 45 with a screw 77(see FIG. 3.) which passes through a hole 78 (see FIG. 7) formed insuture-locking washer 75 and into thumb metacarpal anchor 45.

Sling 40 secures thumb metacarpal anchor 45 to index metacarpal anchor35, whereby to provide, in combination with thumb metacarpal anchor 45and index metacarpal anchor 35, a sling suspension system for supportingthe thumb of a patient after basal joint arthroplasty has been performedto alleviate basal joint arthritis. To this end, in one preferred formof the invention, sling 40 comprises an elongated flexible body (e.g., asuture) having a first end 80 and a second end 85. See FIG. 3. And inone preferred form of the invention, sling 40 includes ananchor-engaging element (not shown), e.g., a knot or looped section ofthe sling, for securing sling 40 to index metacarpal anchor 35 such thatthe sling is attached to index metacarpal anchor 35. Thus, in onepreferred form of the invention, sling 40 comprises first end 80 andsecond end 85 which engage suture-locking washer 75 (which is itselfmounted to thumb metacarpal anchor 45), and an intermediate portion ofthe elongated flexible body (e.g., the suture) which engages indexmetacarpal anchor 35. See FIG. 3.

Suture-locking washer 75 comprises one or more adjustablesuture-securing mechanisms 95 (see FIGS. 9-11) for securing sling 40 tosuture-locking washer 75 of thumb metacarpal anchor 45 such that thesling is adjustably attached to thumb metacarpal anchor 45, as willhereinafter be discussed.

The elongated body of sling 40 may comprise a flexible filament (e.g., asuture, a rope, a web, a tape, etc.), or some other flexible elongatedstructure, i.e., substantially any flexible elongated structure whichwill suffice for the intended purpose, either man-made (e.g.,biocompatible polymers, metals, etc.) or biologic (e.g., cross-linkedcollagen, cross-linked hydrogel, chitosan, etc.), and/or compositestructures. In one preferred form of the invention, sling 40 comprises asuture. Where sling 40 comprises a suture, it should be appreciated thatthe suture can be a hollow or solid core braided suture, a monofilamentsuture, etc. It should also be appreciated that, if desired, sling 40may be constructed and configured so that it is able to slide withrespect to itself, e.g., such as where it has been passed throughitself.

As shown in FIGS. 2 and 3 and discussed above, sling suspension system30 comprises index metacarpal anchor 35 and thumb metacarpal anchor 45,both of which are fixedly secured to hone. In one preferred form of theinvention, index metacarpal anchor 35 and thumb metacarpal anchor 45both comprise screw anchors that engage the bone of a metacarpal andremain affixed to a metacarpal as the associated sling 40 (which iscoupled to index metacarpal anchor 35 and thumb metacarpal anchor 45) istightened and secured (i.e., cinched) to thumb metacarpal anchor 45. Itshould be appreciated that bone anchors having alternative bone-engagingmechanisms (e.g., ribs as opposed to screw threads, or expanding bodies,etc.) may alternatively (or additionally) be utilized, as will beapparent to those skilled in the art in view of the present disclosure.

As shown in FIGS. 2-9, sling 40 preferably comprises two suture strands(preferably high-strength, high-density polyethylene suture or theequivalent) which are looped or tied (or otherwise secured) to the base(i.e., the proximal end) of index metacarpal anchor 35. Alternatively,if desired, sling 40 may comprise a single strand of suture which islooped through (or otherwise secured to) the base (i.e., the proximalend) of index metacarpal anchor 35, e.g., such as by looping the suturethrough sling-engaging element 60 (e.g., a recessed eyelet). The freeends 80, 85 of sling 40 are threaded through suture-securing mechanism95 of suture-locking washer 75. Suture-locking washer 75 is mounted tothumb metacarpal anchor 45 which, in one preferred form of theinvention, comprises a screw anchor. It should be appreciated that, ifdesired, suture-locking washer 75 may, alternatively and/oradditionally, be coupled to index metacarpal anchor 35. However, due tothe clinical ease of pulling the sling relative to the thumb metacarpalanchor 45, in the preferred form of the present invention,suture-locking washer 75 is secured to thumb metacarpal anchor 45 asshown in FIG. 3.

The Suture-Securing Mechanism

Suture-locking washer 75 is mounted to the base (i.e., the proximal end)of thumb metacarpal anchor 45, and comprises the aforementioned at leastone suture-securing mechanism 95. See FIGS. 9-11. Suture-securingmechanism 95 is shown in greater detail in FIGS. 9-12. In one preferredform of the invention, two suture-securing mechanisms 95 are utilized,each of which allows the passage and attachment of a free end 80, 85 ofsling 40 to suture-locking washer 75, as will hereinafter be discussedin further detail. Once index metacarpal anchor 35 is secured to theindex metacarpal, and thumb metacarpal anchor 45 is positioned in thethumb metacarpal, the free end(s) 80, 85 of sling 40 are retracted(i.e., pulled, or “cinched”) as the thumb is positioned relative to theindex finger. Suture-securing mechanisms 95 (shown in flattened form inFIG. 12) engage the first and second ends 80, 85 of sling 40 withsuture-holding elements 100 (e.g., barbs) in order to allow one-waypassage of first and second ends 80, 85 of sling 40 throughsuture-securing mechanisms 95, whereby to enable one-way tightening(i.e., cinching) of sling 40 upon positioning of the thumb metacarpal 15relative to index metacarpal 25. As this occurs, suture-securingmechanisms 95 prevent sling 40 from sliding in the opposite direction oftightening, thereby preventing slipping of sling 40 and affixedlyattaching sling 40 (and thus thumb metacarpal 15 and index metacarpal25) into stable position during healing of the newly reconstructed basaljoint.

The suture-securing mechanisms 95 shown in FIGS. 9-12 generally comprisetubular structures 102 (FIG. 9) which are laser-cut into (or otherwiseformed into) a pattern including suture-holding elements (barbs orteeth) 100 (FIG. 10) which are bent or positioned inwardly when the tubeis assembled so as to form the suture-securing mechanism 95, whereby toengage sling 40.

In one preferred form of the invention, and looking now at FIG. 12,tubular structures 102 start as a flat sheet of material, havesuture-holding elements (barbs or teeth) 100 laser cut into the sheet ofmaterial, and then the sheet of material is bent into a tubularstructure (i.e., tubular structure 102) so as to provide the completesuture-securing mechanisms 95.

Tubular structures 102 of suture-securing mechanisms 95 are fixedlysecured in holes 103 formed in suture-locking washer 75, whereby to fixsuture-securing mechanisms 95 relative to suture-locking washer 75. SeeFIG. 9.

In one preferred form of the invention, tubular structures 102 ofsuture-securing mechanisms 95 are press-fit into holes 103.

In another preferred form of the invention, and looking now at FIGS.13-16, suture-securing mechanisms 95 may also comprise protrusions 105that may be positioned to engage the outer surfaces of suture-lockingwasher 75 so as to maintain the position of the suture-securingmechanisms 95 relative to suture-locking washer 75. If desired, one orboth ends of holes 103 may be provided with a counterbore 110 (FIG. 14)for receiving protrusions 105.

In one preferred form of the invention, suture-securing mechanisms 95may comprise two “rows” and four “columns” (i.e., relative to thelongitudinal axis of the suture-securing mechanism 95) of suture-holdingelements (barbs or teeth) 100 that are offset from one another in orderto prevent compressing sling 40 between the “points” of opposing barbsor teeth 100. Four columns are preferable in order to allowpre-positioning of the barbs or teeth 100 inwardly. Fewer or more rowsof barbs or teeth 100 may be used, provided that the desired pull forceis achieved and the height of anchor washer 75 (which is partiallydetermined by the length of the suture-securing mechanism) is smallenough to limit the profile of the thumb metacarpal anchor 45 (includingthe suture locking washer 75 mounted thereto) from extending above thebase of thumb metacarpal 15 upon deployment of thumb metacarpal anchor45. If desired, suture-securing mechanisms 95 may comprise fewer columnswith longer barb or teeth widths so that the barbs or teeth 100 do notfracture or weaken upon deflecting, and/or barbs or teeth 100 may bepre-positioned inwardly so as to allow engagement of sling 40. Such apattern of barbs or teeth 100 increases the pull force while limitingdamage to sling 40.

It should also be appreciated that alternative shapes and/or numbers ofbarbs or teeth 100 may be utilized to engage sling 40.

Use of the Novel Sling Suspension System

Sling suspension system 30 may be used in the following manner tosupport the thumb of a patient after a basal joint arthroplasty has beenperformed to alleviate basal joint arthritis.

1. The patient's trapezium is excised (see FIG. 2) to alleviate thebasal joint arthritis.

2. Index metacarpal 25 and thumb metacarpal 15 are prepared to receiveindex metacarpal anchor 35 and thumb metacarpal anchor 45, respectively.In one preferred form of the invention, a bone hole is drilled into thethumb side of index metacarpal 25, and a bone hole is drilled into thebase of thumb metacarpal 15. Note that the space created by the excisedtrapezium allows easy access to the base of thumb metacarpal 15 and tothe thumb side of index metacarpal 25.

3. Sling 40 is attached to index metacarpal anchor 35 usingsling-engaging element 60 (e.g., an eyelet) of index metacarpal anchor35 and an anchor-engaging element (e.g., a knot) of sling 40, and sling40 is attached to suture-locking washer 75 and suture-locking washer 75is attached to thumb metacarpal anchor 45, if they are not already inthis arrangement. See FIG. 3.

4. Index metacarpal anchor 35 is secured in the bone hole formed inindex metacarpal 25.

5. Thumb metacarpal anchor 45 is secured in the bone hole formed in thebase of thumb metacarpal 15.

6. The free end(s) 80, 85 of sling 40 is/are tensioned (i.e., cinched),whereby to correctly position thumb metacarpal anchor 45 relative toindex metacarpal anchor 35, and hence to correctly position thumbmetacarpal 15 relative to index metacarpal 25, so as to provide thedesired reconstructed basal joint. See FIG. 3.

7. Free end(s) 80, 85 of secured sling 45 can then be cut with anappropriate instrument if desired.

Alternative Form of Suture-Locking Washer

FIGS. 17-27 show an alternative suture-locking washer 75A wherein theone or more suture-securing mechanisms 95 are formed integral with thebody of suture-locking washer 75A (i.e., the side walls ofsuture-securing mechanisms 95 are the side walls of holes 103 passingthrough the suture-locking washer). See FIGS. 19 and 24-26. In this formof the invention, suture-locking washer 75A comprises multiple holes 103for sling 40 (i.e., a suture) to pass through, with at least one of theholes 103 including suture-holding elements (barbs or teeth) 100positioned so as to allow passage of sling 40 in one direction whilepreventing slippage of the sling in the opposite direction. Others ofholes 103 may omit barbs or teeth 100 (i.e., others of holes 103 maycomprise smooth inside walls).

Deployment Assembly

Looking now at FIGS. 28-30, there is shown a deployment assembly 115which may be used to deploy sling suspension system 30. Moreparticularly, deployment assembly 115 may be used to set indexmetacarpal anchor 35 into index metacarpal 25 (e.g., to insert indexmetacarpal anchor 35 into a bone hole formed in index metacarpal 25)and/or to set thumb metacarpal anchor 45 into thumb metacarpal 15 (e.g.,to insert thumb metacarpal anchor 45 into a bone hole formed in thumbmetacarpal 15). To this end, deployment assembly 115 preferablycomprises a shaft 120 having a drive feature (e.g., a hex driver) 121(FIG. 29) at its distal end for engaging (i) a counterpart drive feature(e.g., a hexagonal recess) 122 (FIG. 3) formed in the proximal end ofindex metacarpal anchor 35 so as to enable deployment assembly 115 to beused to drive index metacarpal anchor 35 into index metacarpal 25,and/or (ii) a counterpart drive feature (e.g., a hexagonal recess) 123(FIG. 9) formed on the proximal end of thumb metacarpal anchor 45 so asto enable deployment assembly 115 to be used to drive thumb metacarpalanchor 45 into thumb metacarpal 15.

A handle 125 (FIG. 28) is provided at the proximal end of shaft 120 ofdeployment assembly 115.

In one exemplary form of the invention, suture-locking washer 75A isaffixed to thumb metacarpal anchor 45 at the time of manufacture, sothat the surgeon does not have to worry about fixing the suture-lockingwasher to the thumb metacarpal anchor at the time of use. See FIG. 28.

And in one exemplary form of the invention, index metacarpal anchor 35is pre-loaded onto the distal end of shaft 120 of deployment assembly115 at the time of system assembly, e.g., as shown in FIGS. 28 and 29.Thumb metacarpal anchor 45, with suture-locking washer 75A pre-affixedthereto, is preferably pre-loaded onto handle 125 of deployment assembly115 (FIGS. 28 and 30). After deployment assembly 115 has been used toset index metacarpal anchor 35 into index metacarpal 25, thumbmetacarpal anchor 45 (with suture-locking washer 75A pre-affixedthereto) is loaded on the distal end of shaft 120 of deployment assembly115 and deployment assembly 115 is then used to set thumb metacarpalanchor 45 (with suture-locking washer 75A pre-affixed thereto) intothumb metacarpal 15.

Where index metacarpal anchor 35 is pre-loaded onto deployment assembly115 at the time of system assembly, deployment assembly 115 ispreferably provided with a channel 130 (FIGS. 28 and 30) that allowspassage of sling 40 along shaft 120 to a suture-locking washer 75Amounted onto a thumb metacarpal anchor 45.

Alternative Deployment Assembly

FIGS. 31 and 32 show another form of deployment assembly 115A, whereinthumb metacarpal anchor 45 is loaded onto shaft 120 of deploymentassembly 115A (as opposed to thumb metacarpal anchor 45 being loadedonto handle 125 of deployment assembly 115).

Another Suture-Locking Washer And Thumb Metacarpal Anchor

FIGS. 33-53 show still another form of suture-locking washer and thumbmetacarpal anchor formed in accordance with the present invention. Moreparticularly, in this form of the invention, there is provided asuture-locking washer 75B comprising at least two suture-securingmechanisms 95B. See FIG. 33. Suture-locking washer 75B is configured tomount to the proximal end of a screw-type thumb metacarpal anchor 45,whereby to permit the suture to be knotlessly secured to thumbmetacarpal anchor 45. Anchor washer 75B is generally C-shaped (FIGS.39-41) and preferably comprises a bore 132 and a counterbore 133,wherein bore 132 receives the shaft 134 of thumb metacarpal anchor 45(FIG. 43) and counterbore 133 receives the head 135 of thumb metacarpalanchor 45, whereby to facilitate mounting anchor washer 75B to theproximal end of thumb metacarpal anchor 45. In this form of theinvention, suture-securing mechanisms 95B preferably comprise aconnecting bar 145 (see FIGS. 33 and 43) for connecting onesuture-securing mechanism 95B to an adjacent suture-securing mechanism95B, and for securing anchor washer 75B to the proximal end of thumbmetacarpal anchor 45. It should be appreciated that anchor washer 75Bmay be secured to thumb metacarpal anchor 45 and/or sling 40 and/ordeployment assembly 115 at the time of manufacture and may be sterilizedas a unit prior to delivery to an end user (e.g., a surgeon).

Suture-Locking Washer for Securing Suture Perpendicular to theLongitudinal Axis of an Anchor

In the foregoing disclosure, suture-locking washers 75, 75A and 75B aredisclosed as having suture-securing mechanisms 95 mounted to thesuture-locking washer such that (a) free end(s) of sling 40 (e.g., thefree end(s) of a suture) can be passed through a given suture-securingmechanism 95 which is, in turn, mounted to a given suture-locking washer75, 75A or 75B, whereby to facilitate knotless securement of the freeend(s) of sling 40 to a suture-locking washer 75, 75A, 75B.

And, in the foregoing disclosure, the aforementioned suture-lockingwashers 75, 75A and 75B are disclosed as having one or moresuture-securing mechanisms 95 disposed parallel to the longitudinal axisof an anchor to which the suture-locking washer 75, 75A and 75B isattached. See, for example, FIGS. 9, 30 and 53.

However, it should also be appreciated that, if desired, the one or moreholes 103 formed in the suture-locking washer which are configured toreceive the one or more suture-securing mechanisms 95 may be disposedperpendicular (rather than parallel) to the longitudinal axis of ananchor to which the suture-locking washer is mounted. Thus, in one formof the invention, suture-securing mechanisms 95 are disposedperpendicular to the longitudinal axis of an anchor to which the suturelocking washer is mounted.

By way of example but not limitation, and looking now at FIGS. 54 and55, there is shown a novel suture-locking washer 75C formed inaccordance with the present invention. Suture-locking washer 75Ccomprises a plurality of holes 103 oriented perpendicular to thelongitudinal axis of an anchor to which suture-locking washer 75C ismounted.

In this form of the invention, and looking now at FIG. 56, holes 103preferably comprise stepped bores 151 and 152, which together define ashoulder 153 formed therein. Shoulder 153 provides a stop for seating asuture-securing mechanism 95 within a hole 103. Note that, if desired,similar shoulders may be provided in holes 103 of suture-locking washers75, 75A and 75B.

It should be appreciated that, in this form of the invention,suture-securing mechanism 95 may also comprise the aforementionedprotrusions 105 for securing suture-securing mechanisms 95 to suturelocking washers 75C, i.e., in the manner previously discussed. See FIG.57. It should also be appreciated that, in this form of the invention,shoulder 153 may be cut-away as appropriate to enable one or moreprotrusions 105 to extend out of bores 151.

In one form of the invention, suture-securing mechanisms 95 may bemounted to suture-locking washer 75C (or to suture-locking washers 75,75A or 75B) before sling 40 is passed through suture-securing mechanisms95.

Alternatively, in another form of the invention, sling 40 may be passedthrough suture-securing mechanism 95 before suture-securing mechanism 95is mounted to suture-locking washer 75C (or to suture-locking washers75, 75A or 75B). More particularly, with this approach, suture-securingmechanisms 95 are mounted to sling 40, e.g., a suture (FIG. 58), thefree ends of sling 40 (e.g., the free ends of a suture) are threadedthrough holes 103 in suture-locking washer 75C (FIG. 59), and thensuture-securing mechanisms 95 are “towed” into place within holes 103(FIG. 60) and secured to the suture-locking washer (FIG. 61).

Component Which May Be Incorporated Into A Suture-Locking Washer

FIGS. 62-65 show a component which may be incorporated into asuture-locking washer, wherein the component incorporates asuture-securing mechanism. More particularly, in this form of theinvention, there is provided a component 154 that comprises a housing155 which includes a pair of openings 160 which receive suture-securingmechanisms 95. If desired, a suture-securing mechanism 95 may bedisposed in an opening 160, or a suture-securing mechanism 95 may bemounted in, and extend between, two aligned openings 160. Furthermore,some of the openings 160 may omit a suture-securing mechanism 95 (i.e.,some of the openings 160 may comprise a smooth-walled bore). Component154 is configured so that it may be incorporated into a suture-lockingwasher of the sort described above, whereby to adjustably secure a sling(e.g., a suture) 40 to component 154, and hence to adjustably secure asling (e.g., a suture) 40 to a suture-locking washer and bone anchor.

Suture-Locking Washer which is not Mounted to A Bone Anchor

In another form of the invention, and looking now at FIG. 66, slingsuspension system 30 may comprise an index metacarpal anchor 35 fordeployment in index metacarpal 25, a thumb metacarpal anchor 45 fordeployment in thumb metacarpal 15, and a sling 40 (e.g., a suture) forsecuring thumb metacarpal anchor 45 to index metacarpal anchor 35. Inthis form of the invention, sling 40 is secured to index metacarpalanchor 35, and sling 40 is slidable relative to thumb metacarpal anchor45. A suture-locking washer 75D is slidably mounted onto sling 40.Suture-locking washer 75D comprises two suture-securing mechanisms 95,wherein the two suture-securing mechanisms 95 are configured to allowsuture movement in opposite directions. More particularly, thesuture-securing mechanism 95 receiving the portion of sling 40 extendingbetween index metacarpal anchor 35 and thumb metacarpal anchor 45 allowssuture movement toward thumb metacarpal anchor 45 but prevents suturemovement toward index metacarpal anchor 35, and the portion of sling 40extending between thumb metacarpal anchor 45 and the othersuture-securing mechanism 95 allows suture movement away from thumbmetacarpal anchor 45 but prevents suture movement toward thumbmetacarpal anchor 45.

In this form of the invention, index metacarpal anchor 35 is disposed inindex metacarpal 25, thumb metacarpal anchor 45 is disposed in thumbmetacarpal 15, thumb metacarpal 15 is positioned in the appropriatelocation relative to index metacarpal 25, and then the free end of sling40 is pulled as suture-locking washer 75D is advanced towards thumbmetacarpal anchor 45 until suture-locking washer 75D is seated againstthumb metacarpal 15. The locking engagement of suture-locking washer 75Dwith sling 40 keeps thumb metacarpal 15 locked against movement relativeto index metacarpal 25.

Bone Anchor Comprising Suture-Securing Mechanisms

If desired, suture-securing mechanisms 95 may be incorporated directlyinto a bone anchor, e.g., holes 103 may be formed in the head of a boneanchor, and suture-securing mechanisms 95 may be disposed in holes 103.In this way, a bone anchor may be provided with a suture-lockingfacility without requiring the use of a separate element (i.e., asuture-locking washer).

Other Medical Devices Comprising Suture-Securing Mechanisms

If desired, suture-securing mechanisms 95 may be incorporated into othermedical devices, e.g., bone plates, etc. In this form of the invention,holes 103 may be formed in the medical device, and suture-securingmechanisms 95 may be disposed in holes 103. In this way, a medicaldevice may be provided with a suture-locking facility.

Applications

In addition to the foregoing, it should also be appreciated that thepresent invention may be used in basal joint arthroplasties which may beconducted for purposes other than alleviating basal joint arthritis,e.g., such as in the case of disease and/or trauma.

Also, suture-locking washer 75 (and suture-locking washers 75B, 75C and75D) and suture-securing mechanisms 95 (and suture-securing mechanism95B) may be applicable to alternative applications that use bone anchorsor other applications which use implantable medical devices. By way ofexample but not limitation, suture-locking washers 75 (andsuture-locking washers 75B, 75C and 75D) may be utilized to provideknotless suture attachment to screw anchors during virtually allorthopedic procedures requiring fixation of suture, utilized toreposition or support the position of tendon, or other soft tissue,relative to bone.

More particularly, and looking now at FIG. 67, where it is desired tosecure a first object (e.g., a bone, soft tissue, etc.) to a secondobject (e.g., a bone, etc.), a bone anchor is disposed in the secondobject, the suture extending away from the bone anchor is passed throughan opening in the first object, and then the suture-locking washer 75(or suture locking washer 75B, 75C or 75D), containing a suture-securingmechanism 95 (or suture-securing mechanism 95B), is loaded onto the freeend of the suture and pushed against the far side of the first object soas to cinch the first object against the second object. In this way, thebone anchor, suture and suture-locking washer can be used to secure thefirst object to the second object.

Applications of the apparatus and methods of the present inventioninclude, but are not limited to rotator cuff repair, tenodesis, medial(ulnar) collateral ligament reconstruction (the “Tommy John Procedure”),lateral ulnar collateral ligament reconstruction, Carpal instabilitytreated with scapholunate and lunotriquetral ligament reconstructions(Blatt Capsulodesis), thumb carpometacarpal arthroplasty (ligamentreconstruction with tendon interposition-LRTI), chronic thumb ulnarcollateral ligament reconstruction (Gamekeeper's thumb), chronic thumbradial collateral ligament reconstruction, finger metacarpophalangealligament reconstruction, medial collateral ligamentrepair/reconstructions with autograft or allograft, lateral collateralligament repair/reconstruction with autograft or allograft,posterolateral reconstruction with autograft or allograft, variouslateral collateral ligament reconstructions (Watson-Jones/ChrismanSnook), or other applications involving securing suture strand(s) tobone in order to secure tendons or other soft tissue to bone.

By way of example but not limitation, see FIG. 68 which shows a halluxvalgus repair using the apparatus and methods of the present invention;FIG. 69 which shows another hallux valgus repair using the apparatus andmethods of the present invention; FIG. 70 which shows an anteriorcruciate ligament (ACL) repair using the apparatus and methods of thepresent invention; FIG. 71 which shows acromioclavicular joint repairusing the apparatus and methods of the present invention; and FIG. 72which shows an ankle syndesmosis repair using the apparatus and methodsof the present invention.

Nomenclature

In the foregoing disclosure, there is disclosed a sling suspensionsystem for supporting the thumb of a patient after basal jointarthroplasty, and the sling suspension system is disclosed as comprisinga sling which may comprise a suture. In addition, in the foregoingdisclosure, there are disclosed apparatus and methods for effectingother orthopedic repairs, wherein the apparatus comprises a sling orsuture. In view of this, in order to render the text more readable,various components have been referred to herein in the context ofsuture, e.g., washers 75A, 75B, 75C and 75D are sometimes referred to as“suture-locking” washers, mechanisms 95 and 95B are sometimes referredto as “suture-securing” mechanisms, and elements 100 are sometimesreferred to as “suture-holding” elements.

However, it should be appreciated that the apparatus and methods of thepresent invention are applicable to a wide range of applications whereelongated elements other than suture per se need to be secured in place.By way of example but not limitation, such other elongated elementsmight comprise non-suture filaments. It will be appreciated by thoseskilled in the art that washers 75A, 75B, 75C and 75D, mechanisms 95 and95B, and elements 100 are equally capable of locking or securing orholding non-suture elongated elements and filaments. Therefore, it willbe appreciated that suture-locking washers 75A, 75B, 75C and 75D mayalso be appropriately referred to as “elongated element-locking” washersor “filament-locking” washers, suture-securing mechanisms 95 and 95B mayalso be appropriately referred to as “elongated element-securing”mechanisms or “filament-securing” mechanisms, and suture-holdingelements 100 may also be appropriately referred to as “elongatedelement-holding” elements or “filament-holding” elements.

Therefore, where the context so admits, suture-locking washers 75A, 75B,75C and 75D should also be considered to be “elongated element-locking”washers or “filament-locking” washers, suture-securing mechanisms 95 and95B should also be considered to be “elongated element-securing”mechanisms or “filament-securing” mechanisms, and suture-holdingelements 100 should also be considered to be “elongated element-holding”elements or “filament-holding” elements.

MODIFICATIONS

It is to be appreciated that the present invention is by no meanslimited to the particular constructions herein disclosed and/or shown inthe drawings, but also comprises any modifications or equivalents withinthe scope of the invention. Although the present invention has beendescribed in terms of the preferred embodiments above, numerousmodifications and/or additions to the above-described preferredembodiments would be readily apparent to one skilled in the art.

What is claimed is:
 1. Apparatus for securing a first anatomical objectto a second anatomical object, said apparatus comprising: a fastenerconfigured to be secured to the second anatomical object, said fastenercomprising: an elongated shaft having a distal end and a proximal end,said elongated shaft being configured to be secured to the secondanatomical object; and an enlarged head having a distal surface and aproximal surface; said enlarged head being secured to said elongatedshaft; a suture-locking washer for seating on said fastener, saidsuture-locking washer being formed separately from said fastener andcomprising: a washer body having a distal surface and a proximalsurface; a first opening extending from said distal surface to saidproximal surface, said first opening being configured to accommodatesaid shaft of said fastener so that said shaft of said fastener can bepassed through said first opening in said washer body and said distalsurface of said enlarged head of said fastener can engage said proximalsurface of said washer body; and a second opening extending completelythrough said washer body; and a tubular structure formed separately fromsaid washer body and disposed in said second opening in said washerbody, said tubular structure comprising a side wall having a first endand a second end and a passageway extending therebetween, saidpassageway being sized to slidingly accommodate a filament therein, aportion of said side wall of said tubular structure projecting into saidpassageway so as to form a barb having a pointed end, wherein said barbis configured to: (i) permit movement of said filament longitudinallyalong said passageway in a first direction when said filament is urgedin said first direction, and (ii) prohibit movement of said filament insaid passageway when said filament is urged in a second direction thatis opposite to said first direction by piercing said filament with saidpointed end of said barb.
 2. Apparatus according to claim 1 wherein saidtubular structure comprises end projections extending out of saidopening in said body and securing said tubular structure in said openingin said body.
 3. Apparatus according to claim 2 wherein said endprojections are bent into engagement with portions of said body adjacentto said opening so as to secure said tubular structure in said opening.4. Apparatus according to claim 1 wherein said second opening in saidwasher body comprises a stepped bore defining a shoulder, and furtherwherein said tubular structure engages said shoulder.
 5. Apparatusaccording to claim 1 wherein said fastener is a bone anchor. 6.Apparatus according to claim 1 wherein said apparatus further comprisesa filament extending through said passageway.
 7. Apparatus according toclaim 1 wherein said apparatus further comprises: a second fastener forsecuring to the first anatomical object, said second fastenercomprising: an elongated shaft having a distal end and a proximal end,said elongated shaft being configured for positioning in the firstanatomical object; and an enlarged head having a distal surface and aproximal surface; said distal surface of said enlarged head beingsecured to said proximal end of said elongated shaft; a secondsuture-locking washer for seating on said second fastener, said secondsuture-locking washer being formed separately from said second fastenerand comprising: a second washer body having a distal surface and aproximal surface; a first opening extending from said distal surface tosaid proximal surface, said first opening being configured toaccommodate said shaft of said second fastener so that said shaft ofsaid second fastener can be passed through said first opening in saidsecond washer body and said distal surface of said enlarged head of saidsecond fastener can engage said proximal surface of said second washerbody; and a second opening extending completely through said secondwasher body; a second tubular structure formed separately from saidwasher body and disposed in said second opening in said second washerbody, said second tubular structure comprising a second side wall havinga first end and a second end and a second passageway extendingtherebetween, said second passageway being sized to slidinglyaccommodate the filament therein, a portion of said second side wall ofsaid second tubular structure projecting into said second passageway soas to provide one-way movement of the filament through said secondpassageway.
 8. Apparatus according to claim 1 wherein a plurality ofportions of said side wall of said tubular structure are cut out of saidside wall of said tubular structure and bent so as to project into saidpassageway, whereby to form a plurality of barbs having a plurality ofpointed ends, wherein said plurality of barbs are configured to: (i)permit movement of said filament longitudinally along said passageway ina first direction when said filament is urged in said first direction,and (ii) prohibit movement of said filament in said passageway when saidfilament is urged in a second direction that is opposite to said firstdirection by piercing said filament with said pointed end of said barb.9. Apparatus according to claim 1 wherein a plurality of portions ofsaid side wall of said tubular structure are cut out of said side wallof said tubular structure and bent so as to project into saidpassageway, whereby to form a plurality of barbs having a plurality ofpointed ends, wherein said plurality of barbs are configured to: (i)permit movement of said filament longitudinally along said passageway ina first direction when said filament is urged in said first direction,and (ii) prohibit movement of said filament in said passageway when saidfilament is urged in a second direction that is opposite to said firstdirection by piercing said filament with said pointed end of said barb;and wherein said plurality of barbs are cut out of said side wall ofsaid tubular structure such that at least two of said plurality of barbsare radially offset relative to one another, such that the barbs of saidat least two of said plurality of barbs contact said side wall of saidtubular structure at points that are diametrically opposed from oneanother.
 10. A method for securing a first anatomical object to a secondanatomical object, said method comprising: providing apparatus forsecuring the first anatomical object to the second anatomical object,said apparatus comprising: a fastener configured to be secured to thesecond anatomical object, said fastener comprising: an elongated shafthaving a distal end and a proximal end, said elongated shaft beingconfigured to be secured to the second anatomical object; and anenlarged head having a distal surface and a proximal surface; saidenlarged head being secured to said elongated shaft; a suture-lockingwasher for seating on said fastener, said suture-locking washer beingformed separately from said fastener and comprising: a washer bodyhaving a distal surface and a proximal surface; a first an openingextending from said distal surface to said proximal surface, said firstopening being configured to accommodate said shaft of said fastener sothat said shaft of said fastener can be passed through said firstopening in said washer body and said distal surface of said enlargedhead of said fastener can engage said proximal surface of said washerbody; and a second opening extending completely through said washerbody; and a tubular structure formed separately from said washer bodyand disposed in said second opening in said washer body, said tubularstructure comprising a side wall having a first end and a second end anda passageway extending therebetween, said passageway being sized toslidingly accommodate a filament therein, a portion of said side wall ofsaid tubular structure projecting into said passageway so as to form abarb having a pointed end, wherein said barb is configured to: (i)permit movement of said filament longitudinally along said passageway ina first direction when said filament is urged in said first direction,and (ii) prohibit movement of said filament in said passageway when saidfilament is urged in a second direction that is opposite to said firstdirection by piercing said filament with said pointed end of said barb;passing said filament through said passageway in said first direction;associating one end of said filament with the second anatomical objectand associating said fastener with the first anatomical object; andmoving said filament in said first direction through said passageway soas to shorten the length of said filament extending between the firstanatomical object and the second anatomical object so as to fixedlyconnect the first anatomical object to the second anatomical object. 11.A method according to claim 10 wherein said fastener is associated withthe first anatomical object using a bone anchor.
 12. A method accordingto claim 10 wherein said fastener is associated with the firstanatomical object by positioning said fastener against a surface of thefirst anatomical object.
 13. A method according to claim 12 wherein saidfilament extends to the surface of the first anatomical object bypassing said filament through a through-hole formed in the firstanatomical object.
 14. A method according to claim 10 wherein saidfilament is associated with the second anatomical object using a boneanchor.
 15. A method according to claim 10 wherein said filament isassociated with the second anatomical object by positioning a secondfastener against a surface of the second anatomical object.
 16. A methodaccording to claim 15 wherein said filament extends to the surface ofthe second anatomical object by passing said filament through athrough-hole formed in the second anatomical object.
 17. A methodaccording to claim 10 wherein a plurality of portions of said side wallof said tubular structure are cut out of said side wall of said tubularstructure and bent so as to project into said passageway, whereby toform a plurality of barbs having a plurality of pointed ends, whereinsaid plurality of barbs are configured to: (i) permit movement of saidfilament longitudinally along said passageway in a first direction whensaid filament is urged in said first direction, and (ii) prohibitmovement of said filament in said passageway when said filament is urgedin a second direction that is opposite to said first direction bypiercing said filament with said pointed end of said barb.
 18. A methodaccording to claim 10 wherein a plurality of portions of said side wallof said tubular structure are cut out of said side wall of said tubularstructure and bent so as to project into said passageway, whereby toform a plurality of barbs having a plurality of pointed ends, whereinsaid plurality of barbs are configured to: (i) permit movement of saidfilament longitudinally along said passageway in a first direction whensaid filament is urged in said first direction, and (ii) prohibitmovement of said filament in said passageway when said filament is urgedin a second direction that is opposite to said first direction bypiercing said filament with said pointed end of said barb; and whereinsaid plurality of barbs are cut out of said side wall of said tubularstructure such that at least two of said plurality of barbs are radiallyoffset relative to one another, such that the barbs of said at least twoof said plurality of barbs contact said side wall of said tubularstructure at points that are diametrically opposed from one another.